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Epilepsy and frequent nocturnal enuresis among children in Shanghai, China

  • Jiayao Shen
    Affiliations
    Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Xiangyu Zheng
    Affiliations
    Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Wei Zhou
    Affiliations
    Department of Nephrology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Xingming Jin
    Affiliations
    Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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  • Jun Ma
    Correspondence
    Correspondence to. Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China.
    Affiliations
    Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Published:October 05, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.09.021

      Summary

      Introduction

      Nocturnal enuresis (NE) is a common elimination problem that affects physical and psychological health of children older than 5 years, and more than 80% of them are primary. Frequent nocturnal enuresis (FNE) usually refers to involuntary urination more than 4 times a week during sleep. Children who frequently wet the bed are more likely to become adults with NE. The arousal dysfunction in response to micturition desire is the main pathogenesis of NE. Epilepsy is a common neurological disorder, which essentially reflects various diseases of brain dysfunction. Previous studies had suggested a possible association between epilepsy and NE.

      Objectives

      To examine the association between epilepsy and FNE and to investigate the related risk factors of FNE.

      Study design

      This was an in-depth analysis of a population-based cross-sectional study in Shanghai, China. There were 74 252 children aged 3–12 years old recruited using the multi-stage stratified cluster random sampling method. After ruling out 11 962 (16.1%) children aged less than 5 years, a total of 62 290 children were included in the study. They were surveyed for the demographic characteristics via questionnaires. In this study, IBM SPSS Statistics Version 23 was used for data analysis. Chi-square, t-test, univariable and multivariable logistic regression models were used.

      Results

      The epilepsy rate was significantly higher in children with FNE (2.1%) than that in children without (0.3%). After adjusting for confounding factors (sex, gestational age, birth weight, maternal age, academic performance, parent’ education level, annual household income and autism spectrum disorder) in multivariable models, the incidence of epilepsy in children with FNE was 6.254 times higher than that in children without. Moreover, the adjusted OR was higher in girls than that in boys. Regarding age, the association between epilepsy and FNE existed exclusively among children aged 9–12 years.

      Discussion

      In the study, epilepsy was significantly associated with FNE, girls and preadolescent children were at higher risk. Puberty begins earlier in girls than in boys. Increased secretion of hormones might affect susceptibility to both epilepsy and FNE. It is hypothesized that persistent brain injury caused by multiple seizures may lead to progression to FNE in patients with NE. However, this was a preliminary investigation. The potential to diagnosis previously unrecognized epilepsy among children with FNE was not addressed by this study.

      Conclusion

      Summary TableMultivariable logistic regression models to analyse the association of Epilepsy with FNE, and the association of Epilepsy with FNE in different genders and age groups.
      Adjusted OR
      The confounding factors included autism spectrum disorder, gestational age, birth weight, maternal age, academic performance, parents’ education level, annual household income and sex.
      95% CI P Value
      Epilepsy 6.254 2.612–14.973 <0.001
      Age
      5–6 years old 6.915 0.882–54.210 0.066
      7–8 years old 0.000 0.000 0.998
      9–12 years old 9.877 3.609–27.027 <0.001
      Gender
      Girl 9.900 2.839–34.521 <0.001
      boy 4.917 1.438–16.811 0.011
      OR: odds ratios, CI: confidence intervals.
      The confounding factors included autism spectrum disorder, gestational age, birth weight, maternal age, academic performance, parents’ education level, annual household income and sex.

      Keywords

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